Risk factors for central hypoventilation in anti-N-methyl-D-aspartate receptor encephalitis

This study aims to identify the risk factors for central hypoventilation in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis.

Patients with anti-NMDAR encephalitis who were hospitalized between January 2020 and January 2025 were identified from the Tianjin Huanhu Hospital database, affiliated with Tianjin University. Patients were categorized into a central hypoventilation group and a non-central hypoventilation group, and potential risk factors were collected. Statistical methods were used to compare the two groups and identify risk factors.

The analysis revealed that the central hypoventilation group exhibited a higher incidence of involuntary movements (χ²=5.662, P=0.017), lower admission Glasgow Coma Scale (GCS) scores (Z=-3.749, P<0.001), and higher cerebrospinal fluid (CSF) antibody titers compared with the non-hypoventilation group (Z=-3.344, P=0.001). Multivariate logistic regression analysis identified only admission GCS score and CSF antibody titer as independent risk factors. A lower GCS score [P=0.018; OR (95% CI): 0.556 (0.343, 0.903)] and a higher CSF antibody titer [P=0.048; OR (95% CI): <0.001 (0.000, 0.903)] significantly increased the likelihood of central hypoventilation.

Disturbances in consciousness and elevated CSF antibody titers are risk factors for central hypoventilation in patients with anti-NMDAR encephalitis. It is imperative to closely monitor the respiratory status and oxygenation levels of patients identified as high-risk, conduct regular blood gas analyses, and implement respiratory support and more aggressive immunotherapy when necessary.